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The concept of ‘manliness’ where a man compelled to handle problems alone seeks help, is considered as a sign of weakness. In depression, when men are pressurized by society to appear robust, it prevents them from expressing their feelings & emotions. Men tend to not seek professional mental-health help even after they show symptomatology or are aware that they need help. Masculinity & stigma are the barriers to help-seeking tendencies. Mental illness stigma creates a potent psychological barrier to treatment-seeking (Corrigan, 2004).
Although people with current or remitted mental illness face discrimination in many forms, previous research suggests that men generally are subjected to more mental illness stigma than women (E.g., Farina, 1981).
What is Stigma?
Stigma refers to the negative attitudes towards disapproval of a person or group experiencing mental health illness rooted in the misconception that symptoms of mental illness are based on a person having a weak character. These perceptions can lead to discrimination, avoidance, and rejection of persons experiencing mental illness. Stigma is a major barrier to seeking mental health help even when a person knows they need it.
According to Merriam-Webster, stigma is a social appearance of disgrace associated with particular qualities, characteristics, or circumstances. Mental health is one such characteristic that society stigmatizes. For those with mental health concerns, stigma includes the risk of public identification leading to lowered self-esteem when a person is labeled as mentally ill. Stigma has emerged as an important barrier to the treatment of depression, schizophrenia, panic disorder, bipolar disorder, and post-traumatic stress disorder.
Social Stigma Related to Mental Illness in Men
Social stigma occurs when the public endorses prejudices toward a stigmatized group. Nam et al. (2013) report social stigma negatively correlates whelp-seeking king attitudes - The higher a person’s perception of public stigma, the less likely that person is to seek mental health help. Younger men hold the most public stigma toward depression and the greatest glorification for men’s suicide compared to all other age groups. Perceived social stigma is when people believe others negatively judge their way if they seek treatment.
When men who hold typical masculine norms were asked to respond with what actions they would take if they displayed symptoms of depression, they responded by talking to their support system, waiting for the symptoms to go away, or doing something to distract themselves like exercise instead of seeking professional help. (Mahalik & Rochlen, 2006)
In a study conducted by McCuske and Galupo, participants rated heterosexual men as more feminine if they sought psychological help for depressive symptoms than if they did not seek help.
The Relationship between Masculinity & Help-Seeking Tendency
Mental health is just as important as physical health. Caring for mental health entails seeking out a mental health professional. Masculinity includes cultural male role norms and masculine ideology. Male role norms are defined as culturally constructed expectations for the behavior of men and masculine ideology is the internalization and interpretation of male role norms. Men are less willing to use mental health services due to their high level of dominant masculinity as when they are helped it is like taking away their autonomy to fix something on their own which goes against their masculine norms.
Structural modeling indicates that conformity to dominant masculine gender norms (“boys don’t cry”) leads to self-stigmatization in depressed men who feel that they should be able to cope with their illness without professional help.
Different Types of Barriers
International literature has identified a comprehensive list of barriers to professional help-seeking among young men, some of them are as follows:
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Denial of emotions and low mental health literacy.
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Young men may experience discomfort, embarrassment, fear, and shame around asking for help.
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Waiting until severely distressed before seeking help.
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Problems with interpreting, managing, and communicating distress can result in young men becoming caught in a cycle of avoidance Biddle et al. (2007).
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Research on attitudes to professional help-seeking has revealed that young men with families having stoic or negative attitudes toward mental health services are less likely to seek help (Judd et al., 2006; Vogel et al., 2007).
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Previous negative experiences (Rickwood et al., 2007)
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Past experiences of professional help-seeking that were unhelpful (Rickwood et al., 2005) not believing professional help-seeking is beneficial or will exacerbate problems (Jorm, 2000; Rickwood et al., 2007; Rughani, Deane, & Wilson, 2011).
Avoiding discussion about mental illness is related to the constant fear of damaged careers, losing respect in society, or being rejected by their own family. Due to this, men believe that approaching mental health professionals would lead to criticism. Therefore, seeking help is not only strongly stigmatized by society but amongst men too.
Maladaptive Strategies: Escape & Avoidance
Much of the discussion around masculine coping behaviors focused on the problematic use of drugs and alcohol. These strategies were reported as “maladaptive,” a means of “escape,” or as a style of avoidant coping that did not deal directly with the problem: -
“I’d wake up having a hard time stomaching the day and then just to make everything kinda go away, I go drink excessive amounts, at least 10 drinks in one sitting.” (Cheick et al., 2009, p. 308).
“I intoxicated myself to escape from suicidal thoughts . . . My doctor was the first one to understand that part of my intoxication was self-medication.” (Biong et al., 2008, p. 39).
Other short-term remedies described as unhelpful were substance abuse, infidelity, and focusing excessively on work (Cheick et al., 2009). Similarly, Brownhill et al. (2002) report the use of drugs and alcohol to “numb” emotional distress among both older and younger men. “Escaping it’” was a key theme, which involved escaping the pain through drugs, alcohol, and/or risk-taking behaviors:
“Anything to escape… anything just to get rid of the hurt and pain and loneliness… smoking pot, you just don’t care…I don’t care that”.
Evidence indicates that alcohol consumption is often an avoidance strategy used instead of confronting the underlying issues of mental illness. Nonetheless, it is important to know that alcohol contributes to prolonged depression as it is a depressant. Alcohol consumption increases the frequency & severity of depressive episodes – as well as reduces the efficacy of antidepressants. Furthermore, self-harm & suicide is more common in people consuming alcohol.
6 million men are affected by depression in the United States every single year. Men (79% of 38,364) die by suicide at a rate four times higher than women (Mental Health America [MHA], 2020). They also die due to alcohol-related causes at 62,000 in comparison to women at 26,000. Men are also two to three times more likely to misuse drugs than women (Center for Behavioral Health Statistics and Quality, 2017). These statistics are disturbing & alarming enough because they reinforce the notion that males deprive themselves of mandatory professional help due to various reasons & suffer the most as mentioned previously.
Healthy Coping Mechanisms
In Australia, a study found that Men use 26 positive strategies to combat depression such as:
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Keep yourself busy.
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Eat healthily.
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Do something to help another person.
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Achieve something (Big/small).
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Accept your sad feelings/’This too shall pass.
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Reward yourself with something enjoyable.
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Feeling humor & helping others.
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Exercise.
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Distract yourself from negative thoughts and/or feelings.
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Notice thoughts & try to change your perspective.
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Take some time out.
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Remind yourself that everyone messes up from time to time.
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Be positive.
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Talk to people close to you or someone you trust, about a problem.
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Change sleeping habits.
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Set goals for the future.
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Having a routine/plan out my time.
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Spend time with a pet.
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Use positive self-talk.
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Cry.
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See a health professional.
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Focus on your life purpose.
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Join a group, community, club, or team.
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Meditate/Mindfulness/Gratitude.
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Follow faith, religion, or spirituality.
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Maintain a relationship with a mentor.
Stigma, and particularly social stigma, is increasingly recognized as a barrier to the treatment of numerous mental disorders. Emerging evidence suggests that disseminating public information about depression may prevent or reduce social stigma against men. Educating patients and their families about mental illness will help them understand that seeking help is not a sign of weakness.
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Biography
Dr. Saadiya Kalania has been a trained and verified active listener on 7 Cups since 12 April 2019. She completed her Bachelors’ in Medicine & Surgery in 2019. Currently, she is enrolled in MSc in Clinical Psychology & is working in a hospital. Her role on 7 Cups involves being an active listener, safety patrol and lightship team member. Some of her achievements at 7 Cups include completion of several Academy programs including the internship wherein she provided 443 hours of active listening for more than 26 weeks, the Community Building Course, Leadership Development Program, as well as the Content Development and Marketing Program. Dr. Saadiya is an enthusiastic writer and is a part of her College Magazine Community. Her main areas of interest include - Self-love, Healthy Relationships, Family, Exercise, Stigmas & Discrimination.